Background/Purpose: To gain experiences with a structured questionnaire for discriminating urgent and non-urgent rheumatology appointments by administrative personnel, designed to include all forms of rheumatic diseases. Second, to discuss the results in view of current literature on referral strategies of rheumatic patients from primary to secondary care, including immune-mediated rheumatic diseases. 

Methods: In our rheumatology unit a rheumatology urgency score (RUS) has been calculated on the basis of a multi-dimensional questionnaire with five main domains: Administrative information (referral mode, subjective urgency), clinical signs, time of maximal symptom presentation, available laboratory and imaging findings. This questionnaire has been routinely used since july 2013 for assigning appointments at initial consultation, with urgency defined as RUS ≥ 4 points. Anonymous score sheets including appointment assignments were provided by the administrative personnel for retrospective analysis. Literature search was last updated in january 2015 to identify evidence for effective strategies reducing waiting times and underlying causes for prolonged waiting times.

Results: Consecutive questionnaires from 153 referrals have been analyzed. Questionnaires with RUS ≥ 4 points were calculated and considered as urgent for 75% of the patients (n = 115). Based on the bimodal distribution curve of waiting times, the cut-off between short and long waiting times was defined as 23 days. Mean waiting time for urgent patients was shorter with 14.4 days (±13.1 days) than for non-urgent appointments with 24.6 days (±15.4 days) (p<0.001). 27.5% of all appointments were assigned independently from RUS, with 40.5% of questionnaires with RUS <4 resulting in a fast appointment and 16.1% of questionnaires with RUS ≥ 4 points resulting in a slow appointment. Without these incorrect assignments, waiting times were shorter for urgent than for non-urgent patients with 8.6 and 38.0 days, respectively (p<0.001). Administrative information, clinical signs, time of maximal symptom presentation, laboratory and imaging findings were available in 99.3 %, 94.1%, 77.1%, 33.3%, and 17% of the questionnaires, respectively.

According to the literature, effective strategies resulting in a reduction of referral delay are rapid access services, early arthritis clinics, triage of referrals with use of referral forms and educational programs for primary care physicians. None of the strategies specifically included patients with immune-mediated rheumatic diseases.

Conclusion: The rheumatology urgency score resulted in a bimodal distribution of waiting times, thus distinguishing between urgent- and non-urgent appointments. To achieve better quality in assignment of urgent appointments, administrative personnel has to be further instructed and motivated. RUS has to be further validated in a prospective approach taking into account the subjective and objective physicians’ feed-back of urgency and final diagnoses.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/experiences-with-a-structured-questionnaire-for-administrative-personnel-to-discriminate-urgent-and-non-urgent-rheumatic-patients-referred-from-primary-to-secondary-care/